- Email: [email protected]
Unusual maxillofacial injury caused by a model airplane
ALDEGHERI,
1009
ADAM, AND HUET
2. Bodmer WF, Bailey EJ,Bodmer J, et al: Localization of the gene for familial adenomatous polyposis on chromosome 5. Nature 328:614, 1987 3. Biilow S: Clinical features in familial polyposis toll: Results of the Danish polyposis register. Dis Colon Rectum 29: 102, 1986 4. Pierce ER, Weisbord T, LMcKusick VA: Gardner’s syndrome: Formal genetics and statistical analysis of a large Canadian kindred. Clin Genet 1:65, 1970 5. Bochetto JF, Raycroft JF, DeInnocentes LW: Multiple polyposis, enostosis and soft tissue tumors. Surg Gynecol Obstet 117:489, 1963 6. Bell B, Mazzaferri EL: Familial adenomatous polyposis (Gardner’s syndrome) and thyroid carcinoma: A case report and review of the literature. Dig Dis Sci 38:185, 1993 7. Nelson RL, Orsay CP, Pearl RK, et al: The protean manifestations of familial polyposis coli. Dis Colon Rectum 31:699, 1988 8. Jagelman DG, DeCrosse JJ, Bussey HJ, et al: Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1:1149, 1988 9. Jagelman DG: Manifestations of familial polyposis coli. Cancer Genet Cytogene T 271319~ 1987 10. JPrvinen HJ, Peltokallio P, Landtman M, et al: Gardner’s stigmas in patients with familial adenomatosis toll. Br J Surg 69:718, 1982 11. Katou F, Motegi K, Baba S: Mandibular lesions in patients with adenomatosis coli. J Craniomaxillofac Surg 17:354, 1989 12. Sondergaard JO, Biilow S,Jarinen H, et al: Dental anomalies in familial adenomatous polyposis coli. Acta Odontol Stand 45:61, 1987 13. Harned RK, Buck JL, Olmstead WW, et al: Extracolonic manifestations of the familial adenomatous polyposis syndromes. AJR Am J Roentgen01 156:481, 1991 J Oral Maxillofac 57: 1009-l 012,
14. Utsunomiya J, Nakamuva T: The occult osteomatous changes in the mandible in patients with familial polyposis coli. Br J Surg 62:45, 1975 15. Takeuchi T, Takenoshita Y, Kubo K, et al: Natural course of jaw lesions in patients with familial adenomatosis coli. Int J Oral Maxillofac Surg 22:226, 1993 16. Gardner EJ: A generic and clinical study of intestinal polyposis, a predisposing factor for carcinoma of the colon and rectum. Am J Hum Genet 3:167,1951 17. Ida M, Nakamura T, Utsunomiya J: Osteomatous changes and tooth abnormalities found in the jaws of patients with adenomatosis coli. Oral Surg 52:2, 1981 18. Harvinen HJ, Peltokallio P, Landtman M, et al: Gardner’s stigmatas in patients with familial adenomatosis coli. Br J Surg 69:718, 1982 19. Rayne J, Orth D: Gardner’s syndrome. Br J Surg 6:11, 1968 20. Coli RD, Moore JP, LaMarche PH, et al: Gardner’s syndrome. Am JDig Dis 15:551, 1970 21. Small IA, Shandler J, Husain M, et al: Gardner’s syndrome with an unusual fibro-osseous lesion of the mandible. Oral Surg 49:477, 1980 22. Weary PE, Lmthicum A, Crawley EP, et al: Gardner’s syndrome. Arch Dermatol90:20, 1964 23. Fader M, Kline SN, Spatz SS, et al: Gardner’s syndrome (intestinal polyposis, osteomas, sebaceous cysts) and a new dental discovery. Oral Surg Oral Med Oral Path01 15:153, 1962 24. Wesler RK, Cullen CL, Bloom WS: Gardner’s syndrome with bilateral osteomas of coronoid process resulting in limited opening. Pediatr Dent 9:1,53,1987 25. Fitzgerald GM: Multiple composite edontomas coinciding with other tumorous conditions. J Am Dent Assoc 30:1408, 1943 26. Zachariades N: Gardner’s syndrome: Report of a family. J Oral Maxillofac Surg 45:438, 1987
Surg 1999
Unusual
Maxillofacial Injury by a Model Airplane
Caused
Alain Aldegheri, MD, * Philippe Adam, MD, f and Pascal Huet, MD* Reports describing maxillofacial trauma have involved a variety of objects, including knives, firearms, nail guns, and spear guns.l-3 In this report, we describe a unusual case involving a model airplane.
*Oral and Maxillofacial Surgeon, Private Practice, “Le Velasquez” Maxillofacial Surgery Center, Marseille, France. tOra1 and Maxillofacial Surgeon, Stomatology and Maxillofacial Surgery Clinic (Professor J. Mercier), University Hospital Center Hotel-Dieu, Names, France. *Oral and Maxillofacial Surgeon, Stomatology and Maxillofacial Surgery Clinic (Professor J. Mercier), University Hospital HotelDieu, Names, France. Address correspondence and reprint requests to Dr Aldegheri: “Le Velasquez” Maxillofacial Surgery Center, 3 rue Daumier, 13008 Marseille, France; e-mail: [email protected] D 1999 American
Association
027%2391/99/5708-0017$3.00/O
of Oral and Maxillofacial
Surgeons
Report
of Case
In July 1993, the 50-year-old president of a model airplane club in the Brittany region of France suffered severe maxillofacial trauma while he was giving safety instructions in the use of model airplanes at an air show. The freak accident occurred as a glider was being catapulted into the air using a spring-actuated launcher. The launcher release mechanism failed, first sending the glider vertically into the air and then pulling it back down to the ground. The glider lodged in the patient’s left cheek. First aid administered at the scene of the accident consisted of compression of the carotid region to control bleeding. No attempt was made to remove the glider from the cheek. The patient was transported to the emergency room of the University Hospital Center in Names, France, in a right lateral decubitus position (Fig 1). On admission to the hospital, the patient was immediately transferred to the operating room for extraction of the glider and assessment and repair of the injuries under general anesthesia. Because the lateral decubitus position caused less pain, the patient was intubated in the awake state, placed under general anesthesia, and then turned on the back. Cervicotomy was required to release the glider, and ligation of the external
1010
Repair
UNUSUAL
consisted
of 1) reconstruction
of the zygomatic
FIGURE
3. View of patient
h4AXILLOFACIAL
at the end of the procedure
INJURY
ALDEGHERI,
ADAM, AND HUET
FIGURE 4. Views of after the accident. A, Frontal view 5 months after the accident showing facial nerve palsy (November, 1993). 5, Frontal view 26 months after the accident [September, 1995) showing improvement in facial nerve palsy. C, lateral view 26 months after the accident showing the residual scars.
1011
1012 mattress suture after placement of suction drains (Fig 3). Postoperatively, facial palsy involving the lower part of the region supplied by the facial nerve was noted and confirmed by an electromyogram (EMG) 2 months after the accident (September 1993). Two early complications occurred within the first month: 1) formation of a swelling in the parotid gland that resolved spontaneously after 15 days and 2) a hypertrophic scar from the cervicotomy that was treated by a Z-plasty under local anesthesia at 4 months (October 1993). To limit contraction of the masseter muscle, physiotherapy was begun early, and this resulted in preservation of mouth opening of greater than 35 mm. A repeated EMG at 9 months (March 1994) showed some recovery from the facial nerve palsy. Reconstructive surgery was performed under general anesthesia in May 1995 (23 months after the accident). The procedure consisted of 1) septoplasty to reopen a collapsed left nostril, 2) placement of an hydroxyapatite implant in the left zygomatic region cheek using a y-mm screw, and 3) correction of the ptosis of the left upper lip using a Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) implant. In September 1995 (26 months after the accident), the patient was satisfied with the results (Fig 4).
UNUSUAL MAXILLOFACKL
INJURY
ing to note that the hypertrophic scar requiring a Z-plasty occurred at the level of the cervicotomy made to release the glider from the neck and not at the level of the traumatic wound. Reconstructive surgery was necessary for rehabilitation of the paralyzed face. Septoplasty was performed to correct a preexisting traumatic nasal septum deformity that was asymptomatic before the accident, but became debilitating because of obstruction of the nose and collapse of the ala as a result of the facial palsy.” Several techniques have been proposed for correction of lip ptosis. ‘8 Use of a GoreTex implant in this patient allowed good alignment of the lip commissure (Fig 4B). This case is unusual not only because of the unusual nature of the accident, but also the duration of follow-up (26 months). Good emergency management followed by careful long-term surveillance, including reconstructive surgery, achieved satisfactory results.
Discussion With the exception of gunshot wounds, the incidence of facial trauma involving nonorganic foreign bodies is relatively low. *,s The injury described in this report is exceptional. Emergency management at the scene of the accident was a major factor in the outcome in this case. No attempt was made to dislodge the airplane from the patient’s cheek at the scene of the accident. This decision probably saved the patient from massive hemorrhage that could have had serious consequences without the presence of a surgical team. The rescue workers also deserve praise for having placed the patient in the right lateral decubitus to reduce pain during transport. Despite the extent of injuries, apposition of the wound edges was good, allowing good healing and some recovery of the facial nerve palsy. It is interest-
References 1. Alpert M, Totan S, Cankayali R, et al: Maxillofacial spear gun accident: Report of two cases. J Oral Maxillofac Surg 55:94, 1997 2. Delsol-Liebel MA, Kaminishi RM, Pineda A: Nail gun injury to the maxillofaciaf region: Report of a case. J Oral Maxillofac Surg 54:632, 1996 3. Sedhom AW, Leathers RD, Belton MJ, et al: Fan blade injury to the maxillofacial region: A case report. J Oral Maxillofac Surg 56:98, 1998 4. Lammers RL: Soft tissue foreign bodies. Ann Emerg Med 17:1336, 1988 JD, Delmore MM, Feinberg SE: Posttraumatic facial 5. Ruskin swelling and draining sinus tract. J Oral Maxillofac Surg 50:1320, 1992 6. Gola R, Carreau JP, Faissal T, et al: Traitement palliatif de la paralysie faciale. Rev Stomatol Chir Maxillofac 96:317, 1995 graft midfacial suspension and upper eyelid 7. Biel MA: Gore-Tex@ gold-weight implantation in rehabilitation of the paralyzed face. Laryngoscope 105:876,1995 a. Divaris M, Abdelmoula M, Rosenstiel M, et al: Procede simple de suspension passive de la commissure labiale paralytique. Rev Stomatol Chii Maxillofac 96:53, 1995
1009
ADAM, AND HUET
2. Bodmer WF, Bailey EJ,Bodmer J, et al: Localization of the gene for familial adenomatous polyposis on chromosome 5. Nature 328:614, 1987 3. Biilow S: Clinical features in familial polyposis toll: Results of the Danish polyposis register. Dis Colon Rectum 29: 102, 1986 4. Pierce ER, Weisbord T, LMcKusick VA: Gardner’s syndrome: Formal genetics and statistical analysis of a large Canadian kindred. Clin Genet 1:65, 1970 5. Bochetto JF, Raycroft JF, DeInnocentes LW: Multiple polyposis, enostosis and soft tissue tumors. Surg Gynecol Obstet 117:489, 1963 6. Bell B, Mazzaferri EL: Familial adenomatous polyposis (Gardner’s syndrome) and thyroid carcinoma: A case report and review of the literature. Dig Dis Sci 38:185, 1993 7. Nelson RL, Orsay CP, Pearl RK, et al: The protean manifestations of familial polyposis coli. Dis Colon Rectum 31:699, 1988 8. Jagelman DG, DeCrosse JJ, Bussey HJ, et al: Upper gastrointestinal cancer in familial adenomatous polyposis. Lancet 1:1149, 1988 9. Jagelman DG: Manifestations of familial polyposis coli. Cancer Genet Cytogene T 271319~ 1987 10. JPrvinen HJ, Peltokallio P, Landtman M, et al: Gardner’s stigmas in patients with familial adenomatosis toll. Br J Surg 69:718, 1982 11. Katou F, Motegi K, Baba S: Mandibular lesions in patients with adenomatosis coli. J Craniomaxillofac Surg 17:354, 1989 12. Sondergaard JO, Biilow S,Jarinen H, et al: Dental anomalies in familial adenomatous polyposis coli. Acta Odontol Stand 45:61, 1987 13. Harned RK, Buck JL, Olmstead WW, et al: Extracolonic manifestations of the familial adenomatous polyposis syndromes. AJR Am J Roentgen01 156:481, 1991 J Oral Maxillofac 57: 1009-l 012,
14. Utsunomiya J, Nakamuva T: The occult osteomatous changes in the mandible in patients with familial polyposis coli. Br J Surg 62:45, 1975 15. Takeuchi T, Takenoshita Y, Kubo K, et al: Natural course of jaw lesions in patients with familial adenomatosis coli. Int J Oral Maxillofac Surg 22:226, 1993 16. Gardner EJ: A generic and clinical study of intestinal polyposis, a predisposing factor for carcinoma of the colon and rectum. Am J Hum Genet 3:167,1951 17. Ida M, Nakamura T, Utsunomiya J: Osteomatous changes and tooth abnormalities found in the jaws of patients with adenomatosis coli. Oral Surg 52:2, 1981 18. Harvinen HJ, Peltokallio P, Landtman M, et al: Gardner’s stigmatas in patients with familial adenomatosis coli. Br J Surg 69:718, 1982 19. Rayne J, Orth D: Gardner’s syndrome. Br J Surg 6:11, 1968 20. Coli RD, Moore JP, LaMarche PH, et al: Gardner’s syndrome. Am JDig Dis 15:551, 1970 21. Small IA, Shandler J, Husain M, et al: Gardner’s syndrome with an unusual fibro-osseous lesion of the mandible. Oral Surg 49:477, 1980 22. Weary PE, Lmthicum A, Crawley EP, et al: Gardner’s syndrome. Arch Dermatol90:20, 1964 23. Fader M, Kline SN, Spatz SS, et al: Gardner’s syndrome (intestinal polyposis, osteomas, sebaceous cysts) and a new dental discovery. Oral Surg Oral Med Oral Path01 15:153, 1962 24. Wesler RK, Cullen CL, Bloom WS: Gardner’s syndrome with bilateral osteomas of coronoid process resulting in limited opening. Pediatr Dent 9:1,53,1987 25. Fitzgerald GM: Multiple composite edontomas coinciding with other tumorous conditions. J Am Dent Assoc 30:1408, 1943 26. Zachariades N: Gardner’s syndrome: Report of a family. J Oral Maxillofac Surg 45:438, 1987
Surg 1999
Unusual
Maxillofacial Injury by a Model Airplane
Caused
Alain Aldegheri, MD, * Philippe Adam, MD, f and Pascal Huet, MD* Reports describing maxillofacial trauma have involved a variety of objects, including knives, firearms, nail guns, and spear guns.l-3 In this report, we describe a unusual case involving a model airplane.
*Oral and Maxillofacial Surgeon, Private Practice, “Le Velasquez” Maxillofacial Surgery Center, Marseille, France. tOra1 and Maxillofacial Surgeon, Stomatology and Maxillofacial Surgery Clinic (Professor J. Mercier), University Hospital Center Hotel-Dieu, Names, France. *Oral and Maxillofacial Surgeon, Stomatology and Maxillofacial Surgery Clinic (Professor J. Mercier), University Hospital HotelDieu, Names, France. Address correspondence and reprint requests to Dr Aldegheri: “Le Velasquez” Maxillofacial Surgery Center, 3 rue Daumier, 13008 Marseille, France; e-mail: [email protected] D 1999 American
Association
027%2391/99/5708-0017$3.00/O
of Oral and Maxillofacial
Surgeons
Report
of Case
In July 1993, the 50-year-old president of a model airplane club in the Brittany region of France suffered severe maxillofacial trauma while he was giving safety instructions in the use of model airplanes at an air show. The freak accident occurred as a glider was being catapulted into the air using a spring-actuated launcher. The launcher release mechanism failed, first sending the glider vertically into the air and then pulling it back down to the ground. The glider lodged in the patient’s left cheek. First aid administered at the scene of the accident consisted of compression of the carotid region to control bleeding. No attempt was made to remove the glider from the cheek. The patient was transported to the emergency room of the University Hospital Center in Names, France, in a right lateral decubitus position (Fig 1). On admission to the hospital, the patient was immediately transferred to the operating room for extraction of the glider and assessment and repair of the injuries under general anesthesia. Because the lateral decubitus position caused less pain, the patient was intubated in the awake state, placed under general anesthesia, and then turned on the back. Cervicotomy was required to release the glider, and ligation of the external
1010
Repair
UNUSUAL
consisted
of 1) reconstruction
of the zygomatic
FIGURE
3. View of patient
h4AXILLOFACIAL
at the end of the procedure
INJURY
ALDEGHERI,
ADAM, AND HUET
FIGURE 4. Views of after the accident. A, Frontal view 5 months after the accident showing facial nerve palsy (November, 1993). 5, Frontal view 26 months after the accident [September, 1995) showing improvement in facial nerve palsy. C, lateral view 26 months after the accident showing the residual scars.
1011
1012 mattress suture after placement of suction drains (Fig 3). Postoperatively, facial palsy involving the lower part of the region supplied by the facial nerve was noted and confirmed by an electromyogram (EMG) 2 months after the accident (September 1993). Two early complications occurred within the first month: 1) formation of a swelling in the parotid gland that resolved spontaneously after 15 days and 2) a hypertrophic scar from the cervicotomy that was treated by a Z-plasty under local anesthesia at 4 months (October 1993). To limit contraction of the masseter muscle, physiotherapy was begun early, and this resulted in preservation of mouth opening of greater than 35 mm. A repeated EMG at 9 months (March 1994) showed some recovery from the facial nerve palsy. Reconstructive surgery was performed under general anesthesia in May 1995 (23 months after the accident). The procedure consisted of 1) septoplasty to reopen a collapsed left nostril, 2) placement of an hydroxyapatite implant in the left zygomatic region cheek using a y-mm screw, and 3) correction of the ptosis of the left upper lip using a Gore-Tex (W.L. Gore and Associates, Flagstaff, AZ) implant. In September 1995 (26 months after the accident), the patient was satisfied with the results (Fig 4).
UNUSUAL MAXILLOFACKL
INJURY
ing to note that the hypertrophic scar requiring a Z-plasty occurred at the level of the cervicotomy made to release the glider from the neck and not at the level of the traumatic wound. Reconstructive surgery was necessary for rehabilitation of the paralyzed face. Septoplasty was performed to correct a preexisting traumatic nasal septum deformity that was asymptomatic before the accident, but became debilitating because of obstruction of the nose and collapse of the ala as a result of the facial palsy.” Several techniques have been proposed for correction of lip ptosis. ‘8 Use of a GoreTex implant in this patient allowed good alignment of the lip commissure (Fig 4B). This case is unusual not only because of the unusual nature of the accident, but also the duration of follow-up (26 months). Good emergency management followed by careful long-term surveillance, including reconstructive surgery, achieved satisfactory results.
Discussion With the exception of gunshot wounds, the incidence of facial trauma involving nonorganic foreign bodies is relatively low. *,s The injury described in this report is exceptional. Emergency management at the scene of the accident was a major factor in the outcome in this case. No attempt was made to dislodge the airplane from the patient’s cheek at the scene of the accident. This decision probably saved the patient from massive hemorrhage that could have had serious consequences without the presence of a surgical team. The rescue workers also deserve praise for having placed the patient in the right lateral decubitus to reduce pain during transport. Despite the extent of injuries, apposition of the wound edges was good, allowing good healing and some recovery of the facial nerve palsy. It is interest-
References 1. Alpert M, Totan S, Cankayali R, et al: Maxillofacial spear gun accident: Report of two cases. J Oral Maxillofac Surg 55:94, 1997 2. Delsol-Liebel MA, Kaminishi RM, Pineda A: Nail gun injury to the maxillofaciaf region: Report of a case. J Oral Maxillofac Surg 54:632, 1996 3. Sedhom AW, Leathers RD, Belton MJ, et al: Fan blade injury to the maxillofacial region: A case report. J Oral Maxillofac Surg 56:98, 1998 4. Lammers RL: Soft tissue foreign bodies. Ann Emerg Med 17:1336, 1988 JD, Delmore MM, Feinberg SE: Posttraumatic facial 5. Ruskin swelling and draining sinus tract. J Oral Maxillofac Surg 50:1320, 1992 6. Gola R, Carreau JP, Faissal T, et al: Traitement palliatif de la paralysie faciale. Rev Stomatol Chir Maxillofac 96:317, 1995 graft midfacial suspension and upper eyelid 7. Biel MA: Gore-Tex@ gold-weight implantation in rehabilitation of the paralyzed face. Laryngoscope 105:876,1995 a. Divaris M, Abdelmoula M, Rosenstiel M, et al: Procede simple de suspension passive de la commissure labiale paralytique. Rev Stomatol Chii Maxillofac 96:53, 1995